Provider Demographics
NPI:1245235076
Name:LEVAN, THERESE-ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESE-ANNE
Middle Name:
Last Name:LEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1403
Mailing Address - Country:US
Mailing Address - Phone:859-276-5577
Mailing Address - Fax:859-277-4048
Practice Address - Street 1:1707 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1403
Practice Address - Country:US
Practice Address - Phone:859-276-5577
Practice Address - Fax:859-277-4048
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31441208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64314412Medicaid
KY64314412Medicaid
KYG97313Medicare UPIN